DÄ internationalArchive22/2021Oxygen Treatment in COVID-19
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We read the important clinical practice guideline with great interest (1). The guideline recommends initiating oxygen (O2) therapy with a partial O2 pressure (pO2) of ≤ 55 mm Hg. In routine clinical practice, oxygen saturation is measured before pO2. A partial pressure of 55 mg Hg (7.3 kPa) corresponds to an arterial saturation of 88%. The optimal target range for O2 therapy for COVID-19 is currently unknown but should follow recommendations for other acute disorders. Evidence based guidelines support a lower limit of oxygen saturation (SpO2) measured by pulse oximetry of 92% in COVID-19 patients receiving O2 therapy (2). Because of endocarditis, microthrombi, hypoxic vasoconstriction, and hypoxia-related modulation of the ACE-2 receptor, a lower target of SpO2 ranges in COVID-19 may not be advisable

(3).

In the German COVID-19 therapeutic guideline, no upper SpO2 threshold is recommended in patients receiving O2 therapy. In meta-analyses, hyperoxemia (an SpO2 >96% while receiving O2 therapy) was associated with higher in-hospital mortality. Furthermore, in patients with progressive respiratory failure e.g. COVID-19, as a result of hyperoxemia while receiving O2 therapy, clinical deterioration is detected later in contrast to O2 therapy applied with an upper SpO2 treshold (4). We agree with the authors’ recommendation to use high-flow nasal cannula (HFNC) oxygen therapy in COVID-19, but HFNC should be administered if conventional O2 therapy fails. The recommended oxygenation index (PO2/FiO2) for initiation of HFNC under 300 mm Hg corresponds to a pO2 of 80 mm Hg (O2 saturation ~95 %) while receiving >1.5 L O2/minute (FiO2 0.27). Other authors recommend administering HFNC in COVID-19 with continuous monitoring only from PO2/FiO2 <150 mm Hg (this corresponds to an O2 saturation ~92 % while receiving >6 L/min). We call for attention to the German national S3 guideline for oxygen therapy in the acute treatment of adults, whose publication is in preparation (https://www.awmf.org/leitlinien/detail/ll/020–021.html).

DOI: 10.3238/arztebl.m2021.0179

Prof. Dr. med. Jens Gottlieb

Klinik für Pneumologie

Medizinische Hochschule Hannover

BREATH/Standort des Deutschen Zentrums für Lungenforschung

gottlieb.jens@mh-hannover.de

Prof. Dr. med. Heinrich Worth

Facharztforum Fürth

Prof. Dr. med. Thomas Volk

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie,

Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg

Prof. Dr. med. Thomas Fühner

Klinik für Pneumologie, Intensiv- und Schlafmedizin

Klinikum Siloah/KRH Klinikum Region Hannover

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Kluge S, Janssens U, Spinner CD, Pfeifer M, Marx G, Karagiannidis C: Clinical practice guideline: Recommendations on in-hospital treatment of patients with COVID-19. Dtsch Arztebl Int 2021; 118: 1–7 VOLLTEXT
2.
Alhazzani W, Møller MH, Arabi YM, et al.: Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020; 46: 854–87 CrossRef MEDLINE PubMed Central
3.
Shenoy N, Luchtel R, Gulani P: Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Med 2020; 18: 260 CrossRef MEDLINE PubMed Central
4.
Beasley R, Aldington S, Robinson S: Is it time to change the approach to oxygen therapy in the breathless patient? Thorax 2007; 62: 840–1 CrossRef MEDLINE PubMed Central
1.Kluge S, Janssens U, Spinner CD, Pfeifer M, Marx G, Karagiannidis C: Clinical practice guideline: Recommendations on in-hospital treatment of patients with COVID-19. Dtsch Arztebl Int 2021; 118: 1–7 VOLLTEXT
2.Alhazzani W, Møller MH, Arabi YM, et al.: Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020; 46: 854–87 CrossRef MEDLINE PubMed Central
3.Shenoy N, Luchtel R, Gulani P: Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Med 2020; 18: 260 CrossRef MEDLINE PubMed Central
4.Beasley R, Aldington S, Robinson S: Is it time to change the approach to oxygen therapy in the breathless patient? Thorax 2007; 62: 840–1 CrossRef MEDLINE PubMed Central

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